Beneath 'Mediscare' talk, who's right?

When the Obama campaign accused Mitt Romney and Paul Ryan of wanting to “end Medicare as we know it,” the two Republicans could have responded: “Yes, you’re right — our country is going broke, and we’re going to have to make some painful choices if we want to survive.”

But they didn’t.

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Instead, Romney and Ryan declared themselves to be the ones who would “save” Medicare — and accused President Barack Obama of being the one who would kill it.

It’s not like Obama is anxious to discuss the details of his plan either since he took a knife to Medicare spending when he signed the Democrats’ health care reform law in 2010.

So you can forget about that high-minded “adult conversation” about entitlement spending that everyone says we ought to have. Obama doesn’t want it, Romney doesn’t want it and the National Republican Congressional Committee officially took it off the table this week with a memo advising candidates not to even utter the words “entitlement reform.”

What we’ll get now is three months of “Mediscare” — with Republicans and Democrats warning daily that the other guy would throw grandma off the cliff.

So who’s right?

They both are — and they both aren’t.

Medicare is going to have to change no matter who wins the White House. Unless Washington does something, the Social Security and Medicare trustees say the Medicare hospital trust fund will start spending more than it takes in come 2024.

Both Obama and Romney say they’ll slow the growth of Medicare spending to make sure that doesn’t happen.

“In some ways, the distinctions are not as sharp as the participants in the shouting match would like one to believe,” said former CBO chief Robert Reischauer, an expert on Medicare financing.

But there’s a lot of shouting. Here’s how to cut through it:

The Democrats’ claim: Ryan and Romney would “end Medicare as we know it.”

Why the Democrats are right: Even Republicans admit that Medicare would change under Ryan’s House Republican budget — that’s the whole point: “If we don’t deal with Medicare, it goes bankrupt,” Ryan told CNBC earlier this year.

“[T]he truth is, we simply cannot continue to pretend that a Medicare on track to become bankrupt at some point is acceptable,” Romney said Monday in Florida.

Ryan would slow Medicare spending by changing the way Medicare works. Instead of giving seniors health insurance, the government would give them “premium support” — money they would have to use to buy insurance from private companies or from the Medicare system.

Republicans argue that free-market competition between health plans will bring premiums down. But if it doesn’t, seniors will be on the hook for the difference between the “premium support” and the premiums.

Democrats see another problem with the Ryan plan. They say that, given the choice, healthier seniors will use their “premium support” — critics call it a “voucher” — to buy insurance from private health plans that can tailor their benefits to appeal to healthier people. Meanwhile, the sickest seniors — the ones whose care will cost the most — will flock to traditional Medicare. That would overburden Medicare, critics say, making it more and more expensive down the road.

“The higher premiums, in turn, could lead more and more of its healthier enrollees to leave traditional Medicare for private plans,” according to the Center on Budget and Policy Priorities. “Over time, traditional Medicare could become less financially viable, and eventually it could unravel, because it would be competing on an un-level playing field in which private plans captured the healthier beneficiaries and incurred lower costs as a result.”